Health Tourism: Fact vs Fiction

Health tourism and the hostile environment
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FICTION: “Health Tourism” is a problem for the NHS

In September this year Matt Hancock announced an additional £1m funding to expand the team of experts responsible for recovering millions of pounds in costs for treating overseas visitors in the NHS.

Since the law changed in 2015 many people are no longer deemed ‘ordinarily resident’ in the UK and are charged for all NHS care at 150% of cost price except for emergency care. Since 2017 the law has ben tightened further, putting pressure on Trusts to collect money from those deemed as ‘non-resident’.

Matt Hancock said: “Our beloved NHS is renowned around the world for providing high quality health care and it is able to do so thanks to the valuable contributions made by hardworking taxpayers - so it is only fair we ask overseas visitors to pay their way as well.

“This new drive will help recoup millions in unclaimed funds for our NHS which can go back into frontline patient care, so the NHS can be there for all of us when we need it most.”

FACT: Government policy on this has developed as part of their “hostile environment”

Government policy on charging upfront for treatment has rendered 600,000 people, including 120,000 children, ineligible for free NHS care. This has put many lives at risk and caused great hardship.

The policy has been opposed by almost all professional bodies representing doctors and midwives, by the health unions and now by the Labour Party which is committed to scrap the charges.

Pregnant women have been particularly targeted: a Freedom of Information request from Save Lewisham Hospital Campaign showed over 500 women in Lewisham and Greenwich NHS Trust in 2018 alone, were asked to pay up to £9,000 for having a baby.

A new report from Maternity Action backed by the Royal College of Midwives (RCM) in September 2019 showed these charges risked making women unable to access appropriate perinatal care.

The 2015 regulations placed a statutory requirement on NHS Trusts to identify and charge people not eligible for free NHS care; it also increased the amount people could be charged to 150% of the national tariff and introduced the Immigration Health Surcharge.

Lewisham Hospital Campaign showed over 500 women in Lewisham and Greenwich NHS Trust in 2018 alone, were asked to pay up to £9,000 for having a baby.

Duty to charge upfront

In 2017 additional regulations placed a statutory duty on NHS Trusts to charge people upfront for treatment if they were found to be ineligible for free NHS care; increased the range of services that were chargeable to include some community and mental health services; and mandated that NHS Trusts record people’s chargeable status on their patient record.

Never before have Trusts been required to charge people upfront for routine NHS care.

The DHSC had originally planned to extend charges to A&E and GP services by 2016 but have delayed this process following outcry from the healthcare community and civil society.

The intention to extend charging still remains and the 2017 regulations should be understood as a first step in any Government plans to extend charging to all NHS services.

So-called ‘health tourism’ is a political concept that is almost ubiquitous in the media and is often pointed to as a major drain on NHS resources. In reality however there is very little evidence to substantiate its existence.

‘Health tourism’ refers to the idea that people travel deliberately to the UK to seek free treatment for a pre-existing condition.

The Government’s own estimate puts the cost of deliberate misuse of the NHS by overseas visitors at £300m at most – equating to roughly 0.3% of the NHS budget. But the majority of this is attributed to British migrants that live overseas and return to the UK to use the NHS.

The £300m figure includes the use of primary care and A&E services and does not take into account an assessment of the likelihood of the people charged being able to pay the bill.

A number of Trusts that have resorted to using bailiffs to chase down unpaid debt, suggesting Trusts are failing to use their discretion to write off debts owed by people that have no means to pay.

The Government itself admits that even if it did extend charging to all services it would still be unable to recoup the total costs.

The Government’s often used refrain “the NHS is a national, not an international, health service” mobilises the myth of ‘health tourism’ to justify a policy that is based on unreliable evidence, causes harm and leads to discrimination.

Nor is it clear how people are selected for checks on their identity and status. The large majority of the thousands now subject to delays and stress as a result of checks have proved to have a legitimate right to NHS treatment.


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